Dear Curofians ,see the x-ray chest of a patient ,aged about 49years ,chronic bee dies smoker about three cuts of beedies per day and he is a driver by profession,H/o cough since three months with h/o sputum with blood occasionally .Cvs ,no abnormality detected .Evening rise of temprature and breathlessness after exertion .Loss of appetite present . Kindly share your views regarding the case and the management of the case . Yours sincerely.Dr.Rajesh Gopal . MBBS IMA PMC Reg no.35726.Ludhiana .



X Ray pictures is suggesting emphysema lung ,it doesn't seem s any cavities,but symptoms favors possible Koch,s so do other investigations like ct scan,bronchoscopy to rule out Koch,s.

Investigations in a Massive hemoptysis with normal chest x-ray often reveals bronchial vessel bleed either resolved spontaneously or complicated by recurrence. To establish the diagnosis few imaging and tests are done step wise. AFTER stabilisation: 1st, active TB is ruled out. Imaging: HRCT and contrast study followed by FOB. If still inconclusive: CTPA and embolization (if required) in same sitting. Life threatening bleed often requires bronchial artery embolization at very early step.

Emphysematous lung fields with marked bronchovascular markings....likely COPD Require baseline, pft ,sputum for afb ,may require ct afterwards Start antibiotics with brochodilators

B/l emphysematous changes with prominent BV markings..anterior first ribs creating false impression of cavity.. go for baseline blood tests ..sputum for AFB with CECT chest

C.o p d. Emphysema both lungs. There is a cavitatory lesion in left mid zone. Do HRCT. Sputum for AFB . It may be malignancy. Brochoalveolar lavage cytology for detection of cancer.

Bilateral cavities Start on ATT

Cavitary pulmonary tuberculosis Start ATT

B/L cavities in apical region.Patient should be put on ATT even if sputum negative.And he should not be on DOTS because there is lot of failure rate.He needs regular ATT.

Tubular heart broncovascular margin prominent do hrct pft 2 decho then decide smokers cough

These are no cavities. Itz just an illusion created by inner border of first rib bilaterally. B/l emphysematous changes. Ct and FOB should be done for evalvation of hemotysis

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